Health and Medical News and Resources

General interest items edited by Janice Flahiff

[Reblog] In Medicine, More May Not Be Better

From the 23 October 2013 item at The Health Care Blog

 

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Physicians love being liked. They also love doing their jobs well. With other incentives, such as monetary returns, dwindling, the elation we get from satisfying a patient as well as providing them good care is what still makes being a doctor special. But is keeping patients satisfied and delivering high-quality care the same thing? And more important, can patients tell if they are getting good care?

Policymakers certainly think so. In fact, under the Affordable Care Act, Medicare, and Medicaid hospital reimbursements are now being tied to patient satisfaction numbers.

But the association between patient satisfaction and the quality of care is far from straightforward, and its validity as a measure of quality is unclear.

In fact, a study published in April and conducted by surgeons at the Johns Hopkins School of Medicine showed that patient satisfaction was not related to the quality of surgical care. And a 2006 study found that patients’ perception of their care had no relationship to the actual technical quality of care they received. Furthermore, a 2012 UC Davis study found that patients with higher satisfaction scores are likely to have more physician visits, longer hospital stays and higher mortality. All this data may indicate that patients are equating more care with better care.

Although patients and their physicians generally have similar goals, that is not always the case. As a resident, who is not paid on a per-service basis, I have no incentive to order extra testing or additional procedures for my patients if they’re not warranted. But one study found that physicians who are paid on a fee-for-service basis and therefore have an incentive to deliver services — needed or not — are more likely to deliver these services (such as an MRI for routine back pain).

On top of that, as another study found, they also are more liked by their patients. It is no wonder then that the number of patients with back pain, one of the most common reasons for physician visits, are increasingly being overmanaged with MRIs and narcotic pain medications.

Consumer satisfaction is a metric that has been used extensively in other industries, and its increasing integration in healthcare may represent a desire to model medicine on industries that lead in efficiency, such as the technology, automobile or airline industries. But healthcare remains fundamentally different.

Consider Medicare’s initiative to have hospitals publicly report their patient outcomes and satisfaction data and have consumers compare them a la computers or SUVs. Of the 13 teaching hospitals within five miles of my apartment, the relationship between the quality of care and patient satisfaction was unclear. Within these hospitals, hospital mortality outcomes did not correlate with satisfaction ratings.

I’m a physician and I had difficulty making sense of the data, so how can we expect everyday people to use them in a meaningful way? Would they prefer a place where they or their relatives are likely to live longer, have a lower risk of readmission and have fewer infections, or a place where their pain would be better managed, their nurses more responsive and their bathrooms cleaner? Although ideally hospitals would score highly in both sets of measures, data suggest that is not necessarily always the case.

Patient visits can sometimes be like family dinners. They are probably not the best occasions to talk about Dad’s smoking habit or Mom’s Xanax addiction. But to maintain shared decision-making, clear and honest communication is vital. And in critical situations, most data suggests that patients want their physicians to be upfront about bleak issues such as life expectancy.

Yet a 2012 study by investigators in the Dana-Farber Cancer Institute found that patients who were better informed about the grim nature of their cancer and the goals of their treatment were less satisfied with their physicians. Such findings put a physician in a quandary: a more informed patient or a more satisfied one?

Emphasizing patient satisfaction and offering incentives to hospitals and physicians to keep their patients satisfied are laudable. But trying to transform patient satisfaction into a catch-all quality metric may not be the right approach. What is really needed is for physicians to take the time to help patients identify the things they need, not just what they want.

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Read the entire article here

 

A patient having his blood pressure taken by a...

A patient having his blood pressure taken by a physician. (Photo credit: Wikipedia)

 

 

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October 24, 2013 Posted by | health care | , , , , , | 1 Comment

Nurses’ Assessment of Hospital Quality Often On the Button

 

From the 8 October 2012 article at Science Daily

A new study from the University of Pennsylvania School of Nursing affirms a straightforward premise: Nurses are accurate barometers of hospital quality.

Perceptions from nurses — the healthcare providers most familiar with the patient experience — about hospital quality of care closely matches the quality indicated by patient outcomes and other long-standing measurements.

“For a complete picture of hospital performance, data from nurses is essential,” said lead author Matthew D. McHugh, a public health policy expert at Penn Nursing. “Their assessments of quality are built on more than an isolated encounter or single process — they are developed over time through a series of interactions and direct observations of care.”

Nurse-reported quality accurately correlated with outcome measures including death and life-threatening post-surgical complications, and patients’ reports of the care experience, wrote Dr. McHugh…

 

 

October 10, 2012 Posted by | health care | , , , , | Leave a comment

Analysis Of Interventions In 5 Diseases Offers Guidelines To Help Close The Gap

 

Racial/Ethnic Disparities in Self-Rated Health Status among Adults with and Without Disabilities — United States, 2004–2006. MMWR 2008:57(39);1069-1073.

 

Chart: General Health Status among US Adults*, by Race or Ethnicity

From the 19th July 2012 article at Medical News Today

Major disparities exist along racial and ethnic lines in the United States for various medical conditions, but guidance is scarce about how to reduce these gaps. Now, a new “roadmap” has been unveiled to give organizations expert guidance on how to improve health equity in their own patient populations.

Finding Answers, a national program based at the University of Chicago and funded by the Robert Wood Johnson Foundation, seeks evidence-based solutions to reduce racial and ethnic health disparities. Its new roadmap, outlined as part of a symposium of six papers published in the Journal of General Internal Medicine (JGIM), builds upon seven years of administering grants, reviewing literature, and providing technical assistance to reduce health disparities.

The roadmap’s architects hope it can provide direction on creating effective and sustainable interventions as the health disparities field shifts from measuring the problem to taking action. ..

…The paper highlights the initial need for recognizing disparities and commitment to their reduction, and suggests that programs to reduce disparities should be integrated into broader quality improvement efforts at clinics, hospitals and other health systems.

“In the past, people did disparities work or quality work, but the two wouldn’t touch one another,” Chin said. “We’re merging the quality improvement field and the disparities field.”

The roadmap also contains advice on designing interventions to address disparities, drawing upon systemic reviews of disparities research in various diseases. Five such reviews – on HIV,colorectal cancer, cervical cancerprostate cancer and asthma – accompany the roadmap article in the JGIM symposium.

Researchers identified characteristics of successful interventions across the five new articles and previously published reviews of cardiovascular disease, diabetesdepression and breast cancer. Effective projects were found to utilize team approaches to care, patient navigation, cultural tailoring, collaboration with non-health care partners such as families or community members, and interactive skill-based training.

The reviews also identified potential targets for reducing health disparities that have yet to be examined..

..While offering general guidelines for best practices, the authors point out that the specifics of any organization’s effort to reduce disparities must be custom-fit to the patient population and community. …

References for this article

The paper, “A Roadmap and Best Practices for Organizations to Reduce Racial and Ethnic Disparities in Health Care,” was published on July 13 by the Journal of General Internal Medicine. Five systematic reviews of disparities interventions in HIV, colorectal cancer, cervical cancer, prostate cancer and asthma accompany the main article. The articles are open access, and can be read here:http://www.springerlink.com/content/0884-8734/27/8/
The publications were funded by Finding Answers: Disparities Research for Change, a Robert Wood Johnson Foundation program, with direction and technical assistance from the University of Chicago. More information about Finding Answers and the Roadmap to Reduce Disparities can be found athttp://www.solvingdisparities.org.
University of Chicago Medical Center

 

 

July 19, 2012 Posted by | Public Health | , , , , , , , | Leave a comment

Performance Measurement – Converting Practice Guidelines Into Quality Measure

English: California OPA Health Care Quality Re...

 

Excerpts from the 19 December blog item by Ha-Vinh at Health Services Authors

Performance incentives have been recently adopted in France by the national health care insurer to remunerate French Doctors. In Health care, when one can not measure outcomes one measures process. But a good process for an individual patient doesn’t reflect necessarily a good process for the average patient studied by the evidence-based medical research. In a precedent post I presented what the heterogeneity of treatment effect means. In the present post I will try to highlight where stands the fundamental difference between professional guidelines and quality assessment tools of physician practice. Guidelines stem from the average patient. A quality assessment tool assesses the individual patient dealing with the heterogeneity or deviation around the mean value. From now on, given the use of guidelines made by health policy makers to evaluate health care professionals, it becomes a priority goal for searchers to take into account this use when writing their guidelines. For that purpose they should more insist on the heterogeneity of their results and perform sub group analysis across the different risk level of disease to which their studied subjects are exposed. They should accurately determine if their recommendations are applicable to subjects with multiple co morbidities. That is only at this condition that guideline will coincide with a sound balanced quality assessment tool for physician practice…

Read the entire article here

Comment I left at this blog item..

Thank you…it reinforces my beliefs about practice guidelines, emphasis on guidelines!
It is good to measure compliance, and have incentives for performance…
Although generalizations can be made about how to best treat diseases/conditions…at the end of the day…it is people, not diseases/conditions..that are the focus of any good health care system…and heterogeneity of treatment effect is an important facet of treating the whole person, not just the disease/condition..

 

 

December 20, 2011 Posted by | health care | , , , | Leave a comment

   

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